Eradication Of Hepatitis C Virus Infection Research Articles

The role of treatment of hepatitis C with direct-acting antiviral agents on glycaemic control in diabetic patients: An updated systematic review and meta-analysis.

Recent studies suggested that successful clearance of chronic Hepatitis C Virus (HCV) by using direct-acting antiviral (DAA) agents could improve glycemic control in patients with diabetes; however, some studies failed to identify this benefit. We conducted a systematic review and meta-analysis to assess the impact of sustained virologic response (SVR) after treatment with DAA agents on glycemic control. Embase, Scopus and PubMed were searched through March 26th, 2023, for all studies evaluating whether eradication of HCV infection with DAAs is associated with an impact on glycemic control. Only studies with data on glycemic control, including haemoglobin A1c (HbA1c), fasting glucose, or Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), at least 12-week post-SVR were included. Sixteen studies met our eligibility criteria and were included in qualitative analysis. The mean HbA1c was 8.05% (95% CI: 7.79%-8.31%) before treatment and 7.19% (95% CI: 6.98%-7.39%) after treatment. There was a significant mean absolute reduction in HbA1c of 0.72% (95% CI: 0.52%-0.93%) with high heterogeneity between studies (I2 = 91.7%). The reduction in HbA1c remained significant in the subgroup analysis at 3 months follow up post SVR [0.74% (95% CI: 0.57%-0.91%)] and at least 6 months follow up [0.66% (95% CI: 0.23%-1.10%)]. We found a significant reduction in HbA1C after SVR in patients with type 2 diabetes mellitus, reflecting better glycemic control with HCV eradication. This data highlights an important extrahepatic benefit of HCV eradication.

The relation between hepatitis C viral infection and follicular lymphoma clinical course and outcome in a single-center study

Background Hepatitis C virus (HCV) infection has been related in the etiology of many lymphomas. Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. This comparative retrospective study aimed to identify a relationship between HCV and FL clinicopathologic features and neoplasm outcome. Patients and methods This study was conducted on 103 patients with FL who attended our institution during 2008–2019. Results The prevalence of patients with HCV FL was 49.5% and showed significant B symptoms (P=0.023), advanced stages (P=0.016) with higher Follicular Lymphoma International Prognostic Index scores (P=0.042). Progression-free survival showed no differences regarding the viral infection or histological grades. Median overall survival showed significant improvement with histological grades 1–2 (P<0.0001), low Follicular Lymphoma International Prognostic Index, and HCV negative patients with FL, especially in the younger subgroup. Conclusion HCV positive patients with FL had a significantly more aggressive clinicopathological presentation and shorter overall survival. Thus, early virology screening and eradication of HCV infection in FL patients may improve the neoplasm course.

A Historical Overview on the Role of Hepatitis B and C Viruses as Aetiological Factors for Hepatocellular Carcinoma

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the leading cause of hepatocellular carcinoma (HCC) worldwide. Currently, HBV-related HCC predominates in Sub-Saharan Africa and South-East-Asia, while HCV-related HCC predominates in northern Africa and in the western world. Liver cirrhosis is the underlying condition in most HBV cases and in nearly all HCV cases. Several cofactors, viral and non-viral, play a role in the progression toward HCC: dual HBV/HCV infection, HDV, HIV, alcohol intake, smoking, diabetes mellitus, obesity, and NAFLD/NASH. HBV vaccine is effective in preventing both infection and HCC; antiviral drugs may suppress HBV replication and eradicate HCV infection, halting progression to HCC. Inequalities exist between high- and low-income countries with respect to vaccine availability and access to antivirals. These factors represent barriers to the control of HCC incidence. Lack of an effective vaccine against HCV is also a serious barrier to HCV elimination and HCC prevention. The most crucial steps and knowledge that have arisen over time on the association between the two major hepatotropic viruses and HCC are discussed in this historical review.

Daclatasvir as a hepatitis C infection treatment option: an up-to-date evaluation

ABSTRACT Introduction Globally, it is estimated that 290,000 patients infected with hepatitis C virus (HCV) died from hepatitis C consequences, including cirrhosis and hepatocellular carcinoma in 2019. Although daclatasvir (DCV), combined with sofosbuvir (SOF), is effective in HCV patients, the new pan-genotypic combinations are considered by many as more cost-effective and successful in eradicating HCV infection. Areas covered This review discusses the safety, efficacy, and cost-effectiveness of DCV as an HCV treatment option based on real-world studies and pharmacoeconomic evaluations. Expert opinion Real-life studies suggest that SOF/DCV has acceptable sustained virological response and can be used successfully to manage HCV. Nonetheless, the use of SOF/DCV is limited by the longer treatment duration in genotype (GT)-3 patients and the need for ribavirin (RBV) in treatment-experienced patients which increases the likelihood of adverse effects. DCV is likely to remain as a therapeutic option for the management of GT-1, GT-2, and GT-4 patients in resource limited settings, while GT-3 patients are more likely to benefit from RBV-free direct-acting antiviral combinations such as SOF/velpatasvir for 12 weeks or glecaprevir/pibrentasvir for 8 weeks. The introduction of generics for these new pan-genotypic drugs would likely eliminate the need for SOF/DCV in the near future.

Health-related quality of life in people receiving opioid agonist treatment and treatment for hepatitis C virus infection

Background In people with chronic hepatitis C virus (HCV) infection, viral eradication is associated with improved health-related quality of life (HRQOL). Objective To assess changes in HRQOL among participants receiving opioid agonist therapy undergoing treatment for HCV infection Methods COSTAR (NCT02251990) was a randomized, double-blind, placebo-controlled study. Adults with HCV infection on opioid agonist therapy received elbasvir (50 mg)/grazoprevir (100 mg) or placebo for 12 weeks. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey version 2 (SF-36v2) Acute Form. Participants remained blinded until 4 weeks after end of treatment. Results Overall, 201 participants received elbasvir/grazoprevir and 100 participants received placebo. Treatment difference mean change from baseline scores (elbasvir/grazoprevir minus placebo) indicated an improvement in HRQOL at 4 weeks after end of treatment in participants receiving elbasvir/grazoprevir versus those receiving placebo, driven by declining HRQOL in those receiving placebo and improved HRQOL in certain domains among participants receiving elbasvir/grazoprevir. Notable differences in SF-36v2 scores were evident in the general health (mean treatment difference [MTD], 6.00; 95% CI, 1.37–10.63), vitality (MTD, 6.81; 95% CI, 1.88–11.75), and mental health (MTD, 5.17; 95% CI, 0.52–9.82) domains and in the mental component summary score (mean, 2.83; 95% CI, 0.29–5.37). No notable between-treatment differences were evident at treatment weeks 4 or 12. Conclusion HRQOL in patients receiving medication for opioid dependence was improved following treatment for HCV infection with elbasvir/grazoprevir, suggesting that eradication of HCV infection with direct-acting antivirals is associated with improved HRQOL. Trial registration number ClinicalTrials.gov, NCT02251990

IBCL-244: Hepatitis C Viral Infection Impact on the Clinicopathological Features and Clinical Outcome in Egyptian Follicular Lymphoma Patients

Context: Hepatitis C virus (HCV) is both hepatotropic and lymphotropic. Chronic HCV infection has been associated with extrahepatic manifestations, especially lymphoproliferative disorders. Follicular lymphoma (FL) is the most common subtype of indolent non-Hodgkin lymphoma. Objective: To clarify the relationship between HCV and FL, we compared the prevalence of clinicopathologic characteristics between HCV-infected and HCV-non-infected FL patients. Design: A comparative retrospective study included 103 FL patients who presented at our institution during 2008-2018. Setting: It was carried out in the Hematology unit at Oncology Center, Mansoura University (OCMU). Patients: 103 patients with FL who were F/M (47.6/52.4%) with mean age 55.36 ± 11.82 years. The prevalence of HCV infection among FL patients was found to be 49.5%. Interventions: They were treated by rituximab ± anthracycline or alkylator-based regimens. Radiotherapy was the treatment of choice in selected low stage I/II. Main Outcome Measures: The impact of HCV infection on clinicopathological features of FL and its impact on clinical outcome. Results: In this study, HCV-positive FL patients commonly had B symptoms (P = 0.023), stage IV (P = 0.016), high FLIPI score (P =0.042) and absent BCL2 expression (P = 0.041). While no differences were detected regarding gender (P =0.28), grade (P = 0.78) and overall response rate (P = 0.2). PFS was significantly improved with low FLIPI score (P = 0.028), meanwhile, no differences were detected regarding HCV-status (P = 0.27) and grade (P = 0.17). Median OS was not reached. It was significantly improved in Grade 1, 2 (P Conclusion: The prevalence of HCV infection among our studied FL patients is ∼49.5%. HCV infection was significantly associated with more aggressive clinicopatholigical features and shortened OS. Thus, early detection and eradication of HCV infection in FL may improve the outcome.

Evaluation of Liver Fibrosis by FibroScan in β-Thalassemia Children Infected with Hepatitis C Virus Before and After Ledipasvir/Sofosbuvir Therapy

Background: Thalassemic children develop liver fibrosis because of liver iron overload and hepatitis C virus (HCV) infection. Transient elastography (FibroScan) can be a reliable non-invasive method for evaluating liver fibrosis in thalassemic patients. Treatment with ledipasvir/sofosbuvir (LED/SOF) direct acting antiviral agents can significantly affect liver stiffness measurement (LSM) by FibroScan.
 Aims: To assess liver fibrosis by non-invasive FibroScan through LSM before and after generic LED/SOF therapy in multi-transfused β-thalassemic children infected with HCV.
 Place and Duration of Study: Pediatric Hematology Unit, Tanta University Hospital, from November 2017 to May 2019.
 Methodology: Fifty multi-transfused β-thalassemic treatment-naϊve children (aged 12-18 years and weighing ≥35kg) with chronic HCV infection were subjected to clinical evaluation, quantitative HCV PCR assay, FibroScan examination, and calculation of APRI, FIB4 index and AST/ ALT ratio. In addition to standard therapy, generic LED/SOF (90/400 mg) treatment was given for 12 weeks’ duration with follow up for further 12 weeks after end of treatment.
 Results: A positive HCV PCR was changed into negative for all studied patients starting from week 4 after treatment. There was highly significant reduction in the LSM values by FibroScan in the studied patients after therapy (p-value <0.001) with median reduction of 19.4 %. The significant reduction in LSM values was particularly prominent in patients with significant (F2) and advanced (F3) liver fibrosis stages as well as cirrhotic patients (F4). There was significant reduction in the values of other non-invasive liver fibrosis markers FIB-4 index, APRI score and AST/ ALT ratio (p-value <0.001, <0.001 and 0.020 respectively) after therapy.
 Conclusion: Generic LED/SOF therapy for 12 weeks’ duration resulted in eradication of HCV infection that was associated with significant decrease in LSM by FibroScan particularly those with higher baseline liver fibrosis stages.

Hepatitis B Virus (HBV) Reactivation Following Pharmacological Eradication of Hepatitis C Virus (HCV)

The US Food and Drug Administration issued a black box warning related to the risk of reactivation of overt/occult hepatitis B virus (HBV) infection during direct acting-antivirals (DAA) treatment. This review evaluated the prevalence of HBV reactivation after hepatitis C virus (HCV) pharmacological suppression and hypothesized the management and prevention of this reactivation. During and after DAA-based treatment, reactivation of HBV infection is common in patients with detectable serum HBsAg (from 2% to 57%) and very low (less than 3%) in individuals with isolated anti-HBc antibodies. The severity of hepatic damage may range from HBV reactivation without hepatitis to fulminant hepatic failure requiring liver transplantation. Thus, HBsAg-positive patients should receive nucleo(s)tide analog (NA) treatment or prophylaxis at the same time as DAA therapy. For those patients with occult B infection, there are no sufficient recommendations to start prophylactic treatment. Reactivation of overt or occult HBV infection during or after eradication of HCV infection is an issue to consider, and additional studies would help to determine the best management of this virological and clinical event.

Clinical outcome of HCV-associated cryoglobulinemic glomerulonephritis following treatment with direct acting antiviral agents: a case-based review.

Newer treatment protocols involving direct-acting antiviral agents (DAAs) have been associated with high rates of sustained virologic response (SVR) and clinical remission in patients with hepatitis C virus (HCV) associated cryoglobulinemic vasculitis (HCV-CV), but clinical response in those with renal involvement is less clear. Our goal was to evaluate the clinical course following DAA therapy in one of the largest cohorts of patients with HCV-associated cryoglobulinemic glomerulonephritis (HCV-GN) reported to date. This is an observational study of patients with chronic HCV infection and circulating cryoglobulins (CC) treated with DAAs in our department from January 2015 to January 2019. We identified a total of 67 patients with HCV and CC out of which nine patients fulfilled the criteria of HCV-GN and had adequate clinical follow-up time. We describe a cohort of nine patients with a mean age of 57years and known duration of HCV infection ranging 3-20years (four with evidence of compensated cirrhosis). All patients received the ritonavir-boosted paritaprevir/ombitasvir/dasabuvir regimen for 12weeks and achieved SVR without subsequent viral relapse. Following DAAs completion, one patient developed "new-onset" cryoglobulinemic glomerulonephritis, six showed either persistent or worsening glomerulonephritis, and only two patients had a complete clinical response (CCR). Of the six patients with either persistent or worsening CV, 67% received additional immunosuppressive (IS) therapy for uncontrolled CV. Of the two patients that had a CCR, one patient received prior IS therapy while the other one improved without any additional intervention. Newer HCV treatment protocols involving DAAs are highly successful in eradication of HCV infection; however, in our experience, DAA treatment alone is insufficient in improving the renal outcomes of patients with HCV-GN and additional IS therapies should be considered.

Eradication of HCV Infection with the Direct-Acting Antiviral Therapy in Renal Allograft Recipients.

Hepatitis C virus (HCV) infection unfavorably affects the survival of both renal patients undergoing hemodialysis and renal transplant recipients. In this subset of patients, the effectiveness and safety of different combinations of interferon-free direct-acting antiviral agents (DAAs) have been analyzed in several small studies. Despite fragmentary, the available data demonstrate that DAA treatment is safe and effective in eradicating HCV infection, with a sustained virologic response (SVR) rates nearly 95% and without an increased risk of allograft rejection. This review article analyzes the results of most published studies on this topic to favor more in-depth knowledge of the readers on the subject. We suggest, however, perseverating in this update as the optimal DAA regimen may not be proposed yet, because of the expected arrival of newer DAAs and of the lack of data from large multicenter randomized controlled trials.

Long-Term Clinical Outcomes After Eradication of HCV Infection with Direct-Acting Antiviral Therapy

Although direct-acting antivirals (DAAs) are effective in the treatment of chronic hepatitis C virus (HCV) infection, the long-term benefits are

Current issues and perspectives in the therapy of hepatitis C virus infection

Hepatitis C virus (HCV) infection is an important public health problem through the high levels of morbidity and mortality that it entails. Although the virus was discovered 30 years ago, the progress made in the structure and pathogenicity of the virus resulted in the development of extreme effective treatments. However, due to the current barriers to universal use of treatment, further efforts are needed to achieve the WHO desiderate to eradicate HCV infection by the year 2030.

Treatment With Grazoprevir/Elbasvir for Renal Transplant Recipients With Chronic Hepatitis C Virus Infection and Impaired Allograft Function.

BackgroundDirect-acing antiviral agents are highly efficient treatment options for chronic hepatitis C virus (HCV) infection after renal allograft transplantation. Treatment options for patients with impaired graft function remain limited. Therefore, we assessed the effectiveness and safety of grazoprevir/elbasvir therapy for patients with chronic HCV infection and impaired renal allograft function.MethodsEleven renal allograft recipients with therapy-naïve HCV genotype (GT) 1a, 1b, or 4 were treated with the fixed-dose combination of elbasvir/grazoprevir without ribavirin for 12 weeks. All recipients exhibited impaired graft function with an average glomerular filtration rate lower than 30 mL/min per 1.73 m2. Clinical data were retrospectively reviewed for renal and liver function parameters. Patients were closely monitored for trough levels of immunosuppressive agents, viral load, laboratory values, and potential adverse effects.ResultsSeven (64%) patients exhibited a rapid virologic response within 4 weeks (HCV GT1a, n = 2; HCV GT1b, n = 5). The other 4 patients exhibited a virologic response within 8 weeks (HCV GT1b, n = 3; HCV GT 4, n = 1). All patients exhibited a sustained virologic response at week 12 after the end of treatment. Clinical measures of liver function improved substantially for all patients. Few adverse effects were reported. Impaired renal allograft function and proteinuria remained stable. For most patients, only moderate adjustments to the tacrolimus dosage were necessary for maintaining sufficient trough levels.ConclusionsThis treatment appears to be safe and effective for renal transplant recipients with impaired allograft function and is a promising treatment option for eradicating HCV infection in this patient population.

PRM131 - HEPATITIS C VIRUS ELIMINATION AND ERADICATION MODELS: A SYSTEMATIC LITERATURE REVIEW

Hepatitis C virus (HCV) elimination is an achievable goal due to highly effective direct-acting antiviral (DAA) therapies. Between 2015-2030, WHO targets globally 1) reduction in new HCV infections by 80%; 2) reduction in HCV deaths by 65%; 3) increase in HCV diagnoses from <5% to 90%; 4) increase in HCV treatment among eligible persons from <1% to 80%. The aim of this study was to systematically review the modeling approaches and results of full-economic evaluations targeting the elimination or eradication of HCV in any geographical setting. By using Scopus and OVID databases a systematic review of English-language articles published between January 2010 and October 2017 was performed, as the appearance of DAAs made the elimination or eradication of HCV a realistic goal after 2010. Data on country setting, modeling approach and results of the observed scenarios were extracted. A total of 504 articles were identified. After title/abstract and full text screening 4 studies were included into the review. These studies used dynamic economic models, compared at least four scenarios, and reported data on the treated patient numbers, total cost of the scenarios, prevalence and/or incidence reduction of HCV and mortality reduction in percentage or absolute numbers. Three of the included studies employed backward calculation to recommend strategies to reach at least one WHO HCV elimination target, the fourth study examined the impact of specific scenarios on HCV elimination and did not consider the WHO targets. Only a limited number of economic analyses were carried out to investigate the consequences of the elimination or eradication of HCV. Our findings suggest that high utilization rate of DAA therapies could help to eradicate HCV infection. However, even with unlimited number of treatment courses, interventions to improve the diagnostics and cascade of care are also required to achieve WHO HCV elimination targets.

Designing a Fusion Protein Vaccine Against HCV: An In Silico Approach

Hepatitis C virus (HCV) infection is a major global issue that leads to serious liver disease such as chronic liver inflammation and hepatocellular carcinoma. At present, no approved vaccine is available for control or treatment of HCV infection. Therefore, the development of an efficient vaccine against HCV is an urgent need. Today, designing an effective vaccine against hepatitis C is one of the outmost propriety for researchers. Fusion protein vaccines containing the immunogen proteins and adjuvant molecules are able to stimulate both humoral and cellular responses that are crucial for eradicating HCV infection. Herein, in silico design of fusion forms of vaccine candidates against HCV, including flagellin (fliC) from Pseudomonas aeruginosa and NS5B antigen (NT300) from HCV was performed. First, two forms of fusion protein (NT300-fliC and fliC-NT300) were designed and analyzed using different bioinformatics tools. For this aim, the Iterative threading assembly refinement (I-TASSER) server was used for modeling the fusion forms of protein; namely, NT300-fliC and fliC-NT300, then the high-rank 3D model of fusion protein was selected, subsequently various physico-chemical, and structural parameters were examined bioinformatically. After the selection of the best construct (fliC-NT300), the interaction of flagellin part of vaccine with toll-like receptor 5 (TLR5) was evaluated via docking studies. Our results represented that based on data obtained from various servers, and the docking analyses of two constructs, fliC-NT300 fusion form showed better results than NT300-fliC. For this reason, the fliC-NT300 form was selected for further evaluations. In sum, structural and immunological computational studies showed that the fliC-NT300 can be introduced as a prophylactic or therapeutic candidate vaccine against the HCV, after the efficacy of that was confirmed via in vitro and in vivo assays.

Large-scale hepatitis C combating campaigns in Egypt and Georgia; past, current and future challenges.

Hepatitis C virus (HCV) infection is a major worldwide problem which should be adequately combated. This review summarizes two successful model programs to eradicate Hepatitis C in two countries; Egypt and Georgia. Egypt tops the list of nations affected by HCV, and Georgia is ranked among other countries with huge HCV burden. Currently, both countries are on their ambitious way to making history and completely eliminate Hepatitis C virus infections. The first comprehensive approach to reduce the burden of hepatitis C and associated diseases in Egypt was achievable with the formulation of the National Committee for Control of Viral Hepatitis (NCCVH) in 2006. Assisted by international and national stalk holders, Georgia started its nation- wide HCV fighting program in 2015. Elements of programs mostly addressed in both countries included simplifying and improving access to the package of diagnosis and care- providing effective, affordable or free of charge treatment- issuing, applying and regularly updating practice guidelines- improving surveillance, monitoring, and research focusing specifically on the risky groups- emphasizing infection control (IC) - encouraging patient and community engagement and increasing public and political commitment. Interventions are still going on to eradicate HCV infection in Egypt by 2030 and in Georgia by 2020. Lessons gained from this program can educate comparable activities in different nations and help control the worldwide epidemic of viral hepatitis.

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows.

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum “not well-defined” follow-up: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection.

The impact of direct-acting antiviral therapy on the diagnosis of hepatitis-C virus-associated hepatocellular carcinoma

Since the introduction of direct-acting antiviral (DAA)-based combination therapies in September 2014 for patients with chronic hepatitis-C (CH-C), numerous patients have been diagnosed with hepatitis-C virus (HCV)-associated hepatocellular carcinomas (HCCs) during the screening performed prior to DAA therapy. The present study was conducted on the antiviral therapy for CH-C in two phases:i) the interferon (IFN) phase between January 2011 and August 2014 and ii) the DAA phase between September 2014 and September 2016. During the DAA phase, HCCs were detected in eight patients who were referred to our hospital for anti-HCV therapy. In contrast, HCCs were detected in only two patients during the IFN phase. The number of patients with newly detected HCC in the DAA phase (20.5%) who were referred for the anti-HCV therapy was significantly higher than that in the IFN phase (1.7%). Owing to the high efficacy and safety of the DAA therapy, the number of patients referred to our hospital for anti-HCV therapy increased from 40.5 persons/year in the IFN phase to 80.3 persons/year in the DAA phase. The average ages of patients in the DAA and IFN phases were 68 and 61 years, respectively. The increase in the number of patients with newly detected HCC referred for the anti-HCV therapy in the DAA phase could be attributed to the increase in the number of referred patients for anti-HCV therapy and the aging of these patients in the DAA phase. All the eight patients with newly detected HCC who were referred for anti-HCV therapy in the DAA phase received curative treatments. The median age, rate of liver cirrhosis, and median tumor size of the patients were 69 years, 13%, and 16mm. Therefore, the findings of this study indicate that DAA therapies not only eradicate HCV infection but also contribute to the early diagnosis of HCC by encouraging the HCV-infected patients to visit hospitals and by promoting active network between hepatologists and family physicians.

Impact of direct-acting antiviral agents on the development of hepatocellular carcinoma: evidence and pathophysiological issues.

Hepatitis C virus (HCV) infection is currently one of the main causes of cirrhosis and hepatocellular carcinoma (HCC) at a global level. Recently, a new generation of direct-acting antiviral agents (DAAs) has entered the HCV treatment landscape, providing impressively high rates of sustained virological response (SVR), and is expected to lead to an eventual decrease in HCV-related cirrhosis, liver transplantation and mortality. However, during the first years of their use, several studies reported a possible correlation between DAA treatment and an increased risk of HCC. Following the publication of larger prospective studies, the risk of de novo HCC occurrence has clearly been proven to be lower after the achievement of SVR, regardless of antiviral treatment. On the other hand, the risk of HCC recurrence following treatment with DAAs is debatable; existing data remain controversial, possibly because of the lack of large, well designed cohorts with more homogeneous patient populations. With regard to the pathophysiology behind the above observations, especially in patients with previous HCC history, HCC development could possibly be favored by the changes in the immunological milieu and the different cellular behavior after eradication of HCV infection with DAA treatment.

Hepatitis C Virus Exposure Rate among Health-care Workers in Rural Lower Egypt Governorates.

Studies on hepatitis C virus (HCV) in Egypt supported a strong role for various exposures in the health-care setting. In this study, we attempted to estimate the frequency of HCV exposure among Egyptian health-care workers (HCWs). Five hundred and sixty-four (564) HCWs were included in this study. Two hundred and fifty-eight (45.74%) were health-care providers and 306 (54.25%) were non-health-care providers. All HCWs completed both the study questionnaire and provided a blood sample for anti-HCV testing by third-generation enzyme-linked immunosorbent assay. Subsequently, anti-HCV-positive samples were tested for HCV RNA using nested polymerase chain reaction (PCR). The mean age of included HCWs was 33.0 ± 9.8 years; of them, 319 (56.56%) were males and 245 (43.44%) were females. The mean duration of health-care work was 9.3 ± 6.7 years. The frequency of antibody against hepatitis C virus (anti-HCV) among included HCWs was 8.7% (n = 49). Old age and prolonged duration of health-care work were significantly associated with anti-HCV seropositivity. Forty (81.63%) of 49 with anti-HCV-positive HCWs had positive hepatitis C viremia. The frequency of HCV RNA positivity increased with age. The frequency of eradicated past infection among nurses (36.85%) was markedly higher than that (6.7%) detected in non-health-care providers. High rate of HCV infection is detected in Egyptian HCWs in rural Lower Egypt governorates. Health-care providers seem to eradicate HCV infection more frequently than non-health-care providers. National screening and treatment of infected HCWs are recommended.